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  • 1
    Electronic Resource
    Electronic Resource
    Nosocomial Infections in a Neurosurgery Intensive Care Unit (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 1303-1308 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Intensive care unit; neurosurgery; nosocomial infection; surveillance.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ In order to identify overall and site-specific nosocomial infection (NI) rates in patients receiving neurosurgical intensive care therapy, a prospective study was started in February 1997 in the eight-bed neurosurgical ICU of the University Hospital of Freiburg, Germany. Case records were reviewed twice a week, all microbiology reports were reviewed and ward staff was consulted. NI were defined according to the CDC-criteria and were categorised into specific infection sites. Within 20 months, 545 patients with a total of 5,117 patient days were investigated (mean length of stay: 9.4 days). 113 NI were identified in 90 patients (72 pts. with one, 13 with two and 5 with three infections, respectively). A moderate to high overall incidence (20.7/100 pts.) and a moderate incidence density (22.1/1,000 patient days) of NI in the neurosurgical ICU could be documented; these figures are well within the range of published data. Site specific incidence rates and incidence densities were: 1 bloodstream infection per 100 patients (0.9 central line-associated BSIs per 1,000 central line-days), 9 pneumonias per 100 patients (15.1 ventilator-associated pneumonias per 1,000 ventilator-days), 7.3 urinary tract infections per 100 patients (8.5 urinary catheter-associated UTIs per 1,000 urinary catheter-days). Additionally, 1.1 cases of meningitis, 0.7 brain abscesses/ventriculitis, and 1.7 other infections (surgical site infection, bronchitis, catheter related local infection, diarrhoea) were documented per 100 patients, respectively. 14.6% of isolated pathogens were E. coli, 10.2% enterococci, 9.6% S. aureus, 6.4% CNS, 6.4% Klebsiella spp., 5% Enterobacter spp. and 5% Pseudomonas spp.. In 11 cases of NI no pathogen could be isolated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050434
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Surveillance of nosocomial infections in dermatology patients in a German university hospital (2003)
    Oxford, UK : Blackwell Science Ltd
    British journal of dermatology 149 (2003), S. 0 
    Details
    ISSN: 1365-2133
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background  Nosocomial infections (NIs) are a growing problem in healthcare today. Thus, surveillance of NIs is an important aspect of modern infection control, which aims to improve the quality of care.Objectives  To identify overall and site-specific NI rates in dermatology patients in a German university hospital.Methods  In a prospective study, 1450 patients were surveyed for NIs according to criteria laid down by the Centers for Disease Control and Prevention. Case records were reviewed twice a week, microbiology reports were assessed and the ward staff was consulted.Results  Altogether, 37 NIs were identified in 35 patients, of whom two had two NIs. The overall incidence was 2·5 NIs per 100 patients, and the incidence density was 1·9 NIs per 1000 patient days. Twenty-one patients developed superficial surgical site infections (SSIs). Thirteen of the 21 SSIs occurred after surgical removal of basal cell carcinoma (BCC; 172 in total). This represents an infection rate of 7·6% after surgery for BCC.Conclusions  Our data suggest that routine surveillance in dermatological wards is not accorded a high priority. However, surveillance of SSIs, especially following surgery for BCC, may be indicated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2133.2003.05477.x
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  • 3
    Electronic Resource
    Electronic Resource
    Filter bei Beatmungstherapie und Inhalationsnarkose? 1. Hygienische und ökonomische Gesichtspunkte bei der Verwendung von Bakterienfiltern (1997)
    Springer
    Intensivmedizin und Notfallmedizin 34 (1997), S. 153-158 
    Details
    ISSN: 1435-1420
    Keywords: Key words Bacterial-filters ; HME-filters ; heat and moisture-exchanger ; respiration-filters ; inhalation anaesthesia ; Schlüsselwörter Bakterienfilter ; HME-Filter ; Künstliche Nase ; Beatmungsfilter ; Inhalationsnarkose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bakterienfilter können bei der Inhalationsnarkose eine Kontamination des Kreissystems durch die respiratorische Flora der Patienten sicher verhindern. Ein Schlauchwechsel nach jeder Operation ist dann nicht mehr erforderlich. Das Wechselintervall der Narkoseschläuche kann auf mindestens einen Tag verlängert werden. Durch Ein-sparungen in der Wiederaufbereitung und geringeren Materialverschleiß werden deutliche ökonomische Vorteile erzielt. Bisher gibt es keinen Hinweis dafür, daß Bakterienfilter die Rate der Beatmungspneumonie senken können. Ihr Einsatz auf Intensivstationen ist damit nicht zu empfehlen. Das Wechselintervall der Beatmungsschläuche kann auch ohne den Einsatz von Bakterienfiltern auf mindestens sieben Tage ausgedehnt werden, ohne einen Anstieg der Pneumonierate zu riskieren. Auch dadurch werden erhebliche Kosten eingespart.
    Notes: Summary Bacterial respiration filters are able to prevent the contamination of anesthetic equipment in inhalation anesthesia. In consequence, no further changes of tubes are required for each patient, and the tubes can be changed daily or at even longer intervals. As a result of an decreased frequency of reprocessing and less damage of the tubing material an economic advantage is obvious. There are no studies indicating a reduction of frequency of pneumonia during mechanical ventilation by bacterial respiration filters. Thus the use of these filters is not recommended in intensive care units. Furthermore, no changes of tubes are recommended every 48 h; they can be changed at least once a week without the use of bacterial respiration filters. This is possible without additional risk for patients to acquire pneumonia and also leads to enormous cost reduction.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050032
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  • 4
    Electronic Resource
    Electronic Resource
    Filter bei Beatmungstherapie und Inhalationsnarkose? 2. Hygienische und ökonomische Gesichtspunkte bei der Verwendung von HME-Filtern (1997)
    Springer
    Intensivmedizin und Notfallmedizin 34 (1997), S. 307-311 
    Details
    ISSN: 1435-1420
    Keywords: Key words HME-filters ; heat and moisture exchanger ; bacterial-filters ; respiration-filters ; inhalation anaesthesia ; Schlüsselwörter HME-Filter ; künstliche Nase ; Bakterienfilter ; Beatmungsfilter ; Inhalationsnarkose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Der Einsatz von HME-Filtern bei Inhalationsnarkosen ist derzeit nicht zu empfehlen, da experimentelle Untersuchungen eine mögliche Keimübertragung vom Patienten auf das Schlauchsystem und umgekehrt gezeigt haben. Repräsentative klinische Studien zur Senkung der postoperativen Pneumonie durch HME-Filter liegen nicht vor. Auch gibt es keinen Hinweis, daß HME-Filter die Rate der Beatmungspneumonie senken können. Beatmungsschläuche von Intensivpatienten können auch ohne HME-Filter erst nach 7 Tagen gewechselt werden ohne eine höhere Pneumonierate zu riskieren. Damit ist der Einsatz von HME-Filtern aus hygienischen Gründen auch auf Intensivstationen nicht notwendig. Die Atemgasklimatisierung mit HME-Filtern hat gegenüber der traditionellen Kaskadenbefeuchtung ökonomische Nachteile.
    Notes: Summary Several studies have shown that HME-filters are not able to prevent the contamination of anesthetic equipment in inhalation anesthesia under experimental conditions. No study could show so far that the frequency of postoperative pneumonia can be decreased with HME-filters. Thus the use of HME-filters in inhalation anesthesia cannot be recommended at present. In addition there are no studies indicating a reduction of frequency of pneumonia during mechanical ventilation by HME-filters in intensive care units. Tubes of mechanical ventilated patients can be changed once a week without the use of HME-filters. This is possible without additional risk for patients to acquire pneumonia. From an economical point of view heat and moisture exchange by cascade is superior to HME-filters. In consequence, for hygienic reasons there is no rational for the use of HME-filters in intensive care units.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050054
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  • 5
    Electronic Resource
    Electronic Resource
    Einweg- versus Mehrweg-Patientenabdeckung im Operationssaal Ökobilanz: Vergleich von Zellstoff-Polyethylen- und Baumwoll-Mischabdeckung (1999)
    Springer
    Der Chirurg 70 (1999), S. 485-491 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Environmental protection ; Disposable products ; Infection control ; Life-cycle assessment ; Reusable products ; Surgical drapes. ; Schlüsselwörter: Umweltschutz ; Einwegprodukte ; Hygiene ; Ökobilanz ; Mehrwegprodukte ; Operationsabdeckmaterialien.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Operationsabdeckmaterialien aus Baumwolle stehen in zunehmender Konkurrenz mit verschiedenen Einwegprodukten oder Mehrwegsystemen aus synthetischen Fasern wie etwa Polyester. Neben Gebrauchstauglichkeit, hygienerelevanten Aspekten und Kosten müssen bei der Auswahl solcher Medizinprodukte für die operative Praxis auch Umweltgesichtspunkte berücksichtigt werden. In der vorliegenden Untersuchung wurde daher eine Mischabdeckung (Baumwolltücher kombiniert mit wenig flüssigkeitsundurchlässigem Zellstoff-Polyethylen-Einwegmaterial) mit einer reinen Einwegabdeckung aus ökologischer Sicht verglichen (Produkt-Ökobilanz). Zu den medizinischen Nutzenaspekten von Operationsabdeckmaterialien wurde eine Literaturrecherche durchgeführt. Aus hygienischer Sicht ist demnach die Mischabdeckung nach derzeitigem Wissensstand als sicheres Verfahren einzuschätzen, ebenso wie die alleinige Abdeckung mit flüssigkeitsdichten Einwegmaterialien. Unter den zugrundegelegten und beschriebenen Vergleichsbedingungen der Ökobilanz führt die Mischabdeckung allerdings zu einem etwa doppelt so hohen Energieverbrauch, zu höheren Kohlendioxid-Emissionen und einem vermehrten Wasserverbrauch. Bei Einwegabdeckung mit Zellstoff/PE-Material fallen mehr Abfälle an. Bei der Wasserbelastung ist die Situation uneinheitlich. Der Vergleich verschiedener Umweltaspekte wie z. B. der umweltbelastende Anbau von Baumwolle außerhalb Deutschlands mit der höheren Verkehrsbelastung durch den Transport von Einwegabdeckungen innerhalb Deutschlands ist nur mit Einschränkungen möglich. Ein wesentlicher struktureller Nachteil der Mischabdeckung ist die Kombination der ökologischen Nachteile von Baumwolle mit denen einer Zellstoff/PE-Einwegabdeckung.
    Notes: Summary. Surgical drapes made of cotton are under increasing competition with various disposable products and reusable draping systems (e. g., made of synthetic fabrics like polyester). When making a choice to use one of these medical devices in practical surgery, major aspects like handling, hygienic safety and costs, but also environmental effects have to be taken into account. In this study a mixed system for patient drapes (reusable cotton drapes combined with a reduced set of impermeable single-use drapes made of cellulose/polyethylene) was compared to a system that is only based on single-use drapes with regard to ecology [life-cycle assessment (LCA)]. The medical literature was reviewed to assess important medical aspects of the use of patient drapes, resulting in the statement that there are no conclusive arguments to support a clear hygienic superiority of one of these alternatives. Based on the conditions assumed and stated, the results of the LCA indicate that the mixed draping system is associated with two times more total energy consumption. In addition, more water is needed and more CO2 emissions are produced. However, draping with the single-use product results in more clinical waste. Regarding water pollution no system proved superior. It is difficult to compare and weigh various environmental aspects like the polluting cultivation of cotton in distant countries (reusable drapes) and the higher figure of transportation necessary to deliver the single-use product within Germany. It is an important disadvantage of the mixed system that it combines the ecological burden of both cotton drapes and the single-use alternative.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050677
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